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Arthroscopy

Arthroscopy or arthroscopic surgery

Arthroscopy is a procedure used to examine the inside of a joint by inserting a thin tube (arthroscope) containing a camera and light through small cuts (incisions) near the joint. The camera sends a close-up video image of the joint to a TV monitor, where the doctor can look at the inside of the joint.

Arthroscopy can be used to diagnose joint diseases and injuries and to treat some joint problems. The doctor can insert surgical instruments through the arthroscope to take tissue samples or to repair injuries or damage to the joint. The doctor may make other small incisions in the joint to insert other instruments.

Generally, recovery after arthroscopic surgery is quicker and easier than after traditional surgery that uses larger incisions. Most people can go home from the hospital the same day.

  • How it's done

    Arthroscopic procedure

    Common sites for arthroscopy, with detail of incision points in knee joint

    Arthroscopic surgery (arthroscopy) is a surgical procedure that allows your doctor to look at the inside of a joint in your body through a thin viewing instrument called an arthroscope. Common sites for the procedure include the shoulder, hip, and knee.

    During arthroscopy, the arthroscope is inserted into your joint through a small cut (incision) in the skin. The arthroscope has a light source and a video camera attached to it. Images from the camera can be seen on a video monitor. These magnified images provide a clear picture of your joint. A sample of joint tissue can be collected during arthroscopy for biopsy. If surgery is done, additional instruments will be inserted into your joint through other small incisions.

    How is arthroscopic surgery (general) done?

    Arthroscopy is usually done by a doctor who specializes in bone, muscle, and joint surgery (orthopedic surgeon).

    You will be asked to remove any jewelry and to wear a hospital gown. You may be given a sedative shortly before the procedure to help you relax. The skin around your joint may be shaved.

    During the procedure

    If general or regional anesthesia is used, an anesthesia specialist will give the medicine. A general anesthetic will make you sleep during the procedure. Your heart rate and rhythm, blood pressure, and breathing will be watched closely during the procedure. If a local anesthetic is used, it will be injected into the skin and joint space. If a local or regional anesthetic is used, your limb will be numb. You will be relaxed and drowsy but will be awake.

    You probably will lie on your back. Depending on which joint is being looked at, an inflatable band (tourniquet) may be used to briefly restrict blood flow to your joint. This allows your doctor to see all the parts inside your joint. Your joint is scrubbed with an antiseptic solution and draped with sterile towels. Before the tourniquet is inflated, the joint will be raised. It may also be wrapped with an elastic bandage to reduce blood flow to the joint.

    A small incision about 0.25 in. (0.6 cm) will be made near your joint. Before the doctor inserts the arthroscope, an irrigation fluid (usually saline) will be used to flush the joint space. This gives the doctor a better view of the entire joint. A steady low flow of fluid is usually used during the procedure. This clears out any debris or blood in the joint so your doctor can evaluate your joint.

    After the scope is put in, your doctor will be able to see inside the joint by viewing a video screen attached to the scope. Your doctor or the surgical assistants may bend, extend, and change the position of the joint to see it from different angles. Videotapes or photos of the joint may also be taken.

    If more surgery is needed to repair your joint problem, more small incisions will be made. Other thin tools will be put into your joint. When the arthroscope and any other tools are taken out, any blood and debris will be flushed with saline and drained. To reduce swelling or pain, local anesthetics or corticosteroids may be injected into your joint.

    The small incision is closed with stitches. Depending on which joint was looked at, you may need to use splints, slings, or crutches while you recover from surgery.

    How long the procedure takes depends on what is done. It may take only about 15 minutes, but it could take an hour or longer.

    After the procedure

    After the procedure, you may need to rest your joint for several days. You may not be able to drive for 24 hours. This will depend on which joint was looked at and what type of anesthetic you had. If your stitches aren't the type that dissolve over time, they will be removed in 7 to 10 days. You can use ice, elevation, and a compression bandage to reduce any swelling. And you can take pain relievers to relieve any pain or discomfort. Ask your doctor for advice on strengthening your joint with exercise and when you can do your normal activities.

  • Why it's done

    Why is arthroscopic surgery (general) done?

    Arthroscopy is used to:

    • Evaluate and diagnose a joint problem when a physical exam and other tests don't give a clear result. These tests may include X-rays, blood tests, CT scans, or magnetic resonance imaging (MRI).
    • Do surgery to repair a joint problem.

    It may be used during surgery to:

    • Shave bone tissue to remove calcium deposits or bone spurs.
    • Repair or trim soft tissues, such as ligaments, tendons, or cartilage.
    • Cut ligaments to help relieve tightness in a stiff joint. They can also be repaired or rebuilt.
    • Collect a sample of joint tissue or joint fluid (synovial fluid) for testing (biopsy).
    • Remove scar tissue or an area of joint lining (synovium) that is swollen.

    Some joint problems may be repaired using arthroscopy with open surgery.

  • After care

    What do the results of arthroscopic surgery (general) mean?

    In most cases, your doctor will be able to discuss the results with you right after the test.

    Arthroscopy

    Normal:

    In a normal, healthy joint, the ligaments look like white cables. The cartilage is smooth and white. The joint fluid is clear, and there are no loose pieces of tissue in the joint. If there is no damage or disease seen in the joint, your doctor may conclude that your joint is normal and isn't the cause of your symptoms.

    Abnormal:

    In a damaged or diseased joint, the ligaments and cartilage are abnormal in color and shape. If there is damage or disease in the joint, your doctor may identify the condition. Your doctor may even do surgery during the arthroscopy to repair the joint problem. Examples of damage or disease in the joint include:

    • Torn, displaced, or loose fragments of soft tissues (such as ligaments or cartilage).
    • Abnormal growths, cysts, or ganglions.
    • Signs of joint or cartilage damage caused by injury or diseases such as arthritis.
    • Infection.

    After your doctor has evaluated your joint, you may need more treatment. This could be medicine, physical therapy, or surgery.

    What can affect the results of arthroscopic surgery (general)?

    You may not be able to have the test, or the results may not be helpful, if:

    • You had an X-ray of the joint that used contrast material (arthrogram) within the previous 10 days. The contrast material may cause swelling inside the joint. The swelling can prevent a clear picture of the joint during arthroscopy.
    • You have arthritis. Joint damage caused by arthritis may make it difficult or impossible to do this procedure.
    • You have some other medical condition, such as a thickening of tissue (fibrosis) in the joint area or widespread infection (sepsis).

What happens after arthroscopic surgery (general)?

After the procedure, you may notice bruises around the incision. This will not last long. The bruising should disappear within 2 weeks. Your joint probably will feel tender for about a week. Ask your doctor how much bleeding, drainage, or swelling from the incision site to expect. If you needed more extensive joint surgery, you may have more bleeding, drainage, pain, and swelling than if you had a simpler surgery.

You may have some soreness and pain. Your doctor will give you instructions on using pain medicine and applying ice to your joint to reduce swelling and pain. You may also need to prop up your joint on pillows. You will have bandages to cover your incision. Keep them clean and dry.

You may need to rest your joint for several days. You may not be able to drive for 24 hours. This will depend on which joint was looked at and what type of anesthetic you had. If your stitches aren't the type that dissolve over time, they will be removed in 7 to 10 days. Ask your doctor for advice on strengthening your joint with exercise, and find out when you can do your normal activities.

  • Before care

    How long does arthroscopic surgery (general) take?

    How long the procedure takes depends on what is done. It may take only about 15 minutes. But it could take an hour or longer.

    How does having arthroscopic surgery (general) feel?

    If you get a local anesthetic before the procedure, you will feel a brief burning or stinging in your skin. As the arthroscope is put into the joint, you will notice a thumping feeling. You may feel slight pulling in the joint area as your doctor moves joint structures around.

    If you get a general anesthetic, you will be asleep. You won't feel anything. If you get a regional anesthetic, your arm or leg will be numb for several hours.

    How do you prepare for arthroscopic surgery (general)?

    Arthroscopic surgery is often done on an outpatient basis without the need for an overnight stay in a hospital.

    You may have more tests, such as blood tests or urine tests, before your procedure.

    Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.

    If you have arthroscopy of your ankle, knee, or hip, your doctor will talk to you about using crutches after the procedure. If you have arthroscopy of a joint in your arm, you will likely wear a sling or splint afterward.